In Japan, a majority of people end their lives in hospital, surrounded by high-technology equipment. Yet in a recent survey over half the respondents said they would prefer to die at home. There has been a tradition of not explaining to terminally ill people the true nature of their condition, on the ground that this is the kindest way to proceed. However, views about this matter are changing. In a recent nationwide opinion poll (1), 65% of the participants said that if they were terminally ill they would like to be given full diagnostic information about themselves. Only 22% of the people questioned, however, said they themselves would definitely be prepared to disclose such information to a member of their family.
The same survey indicated that 78% of people considered palliative care desirable, even though it might shorten life; 16% thought life should be sustained as long as possible, irrespective of the pain that patients might be suffering.
The National Matsudo Hospital is one of the few hospitals in Japan with a palliative care unit. The use of morphine has significantly reduced pain levels for a high proportion of the patients in this establishment; in 1987, 75% of cancer inpatients were given end-stage fluid therapy but in 1990 the proportion had dropped to 12.5% because many families realized that the treatment shortened patients' lives.
A special task force on terminal care, set up by the Ministry of Health and Welfare, issued a report in 1989 which encouraged the disclosure of diagnostic information to patients, provided that consideration was given to patients' life histories, personalities, relationships with family members, and other factors. The use of drugs for pain control was favoured, and the report also dealt with various additional matters touched on by Dr. Abiven, including spiritual requirements and the care of family members.
| People should not have to accept without question the authority of doctors in the treatment of disease. |
The view is gaining ground in Japan that people should not have to accept without question the authority of doctors in the treatment of disease. Unfortunately, there are still too few trained people to cope with the many problems associated with dying. Responsibility for the care of the dying should be shared between health professionals and other carers. Changes are needed in the mentalities of both health care providers and patients, and it has to be recognized that medical system and institutions are not immutable.
Efforts have been made to improve the care of the dying by some volunteers and hospitals in Tokyo, Osaka and elsewhere. There are signs of public approval for such work and the government has begun to provide financial support for palliative care through the national health insurance system.
1 Kimura, R. [Telling the truth to patients is on the increase. Comments on a national opinion poll.] Yomiuri Shimbun, 15 June 1991, p. 12 (in Japanese).
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